157.09 Termination at Redetermination (MAM)

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Terminate medical assistance if any of the following apply:

·         the MA case (MAGI MA or non-MAGI MA) no longer meets eligibility criteria;

·         the non-MAGI MA case is participating in the mail-in redetermination process and fails to return a completed DFA Form 800R or DFA Form 771A, if in a nursing facility, without good cause;

·         the MA case (non-passive MAGI MA or non-MAGI MA) is participating in the online redetermination process and fails to complete the online Redetermination Application without good cause;

·         the non-MAGI MA case is participating in the face-to-face redetermination process, and has not completed an application (DFA Form 800, DFA Form 800MA, or DFA Form 800HR), fails to qualify for an exception, and fails to:

-         attend the scheduled interview appointment without good cause; or

-         contact DHHS to reschedule an appointment;

·         the non-MAGI MA case fails or refuses to appear for a redetermination interview, if required, without good cause; or

·         the MA case (non-passive MAGI MA or non-MAGI MA) refuses or fails to provide the required verification within timeframes.

·         the non-passive MAGI MA case refuses or fails to submit the corrected, signed and dated case information in the CS0006/CS0027 within MAGI MA renewal timeframes.

Exceptions:

·         When a third party has not responded to a request for verification within timeframes, send a follow-up request to the third party and to the MA case. Allow an additional 10 working days for a response. If verification is not provided within the second waiting period, terminate assistance unless the individual provides other acceptable verification.

·         Extend the redetermination date out an additional 6 months for recipients of the Medicare Savings Program (MSP) when the following applies:

-         the case is not receiving any category of financial assistance or any category of In and Out medical assistance at the time of closing;

-         the only other categories of assistance the case is receiving at the time of closing other than MSP, is Food Stamp assistance, including expedited Food Stamp benefits, Children's Medicaid (CM), or Child Care assistance; and

-         the case fails or refuses to complete the online, mail-in, or face-to-face redetermination process for Food Stamp or Child Care assistance. The reason the Expedited Food Stamp assistance is ending can only be due to failure to provide verification. If, for example, the case is closing due to being over income, the changed income information must be applied to all categories of assistance the case is receiving, even if this new information results in termination of MSP.

·         Continue medical assistance for a newborn for 12 months from the child's date of birth.

·         Cancel the termination if the non-MAGI MA case contacts DHHS within the advance notice period and arranges to complete the redetermination process by:

-         completing DFA Form 800, DFA Form 800MA, the online Redetermination Application, DFA Form 800R, or Form 800HR;

-         rescheduling the appointment that was missed; or

-         providing all the required verification.

·         If MAGI MA was terminated due to failure to provide requested verification listed on the New HEIGHTS-generated CS0006/*CS0027 and the case subsequently provides all requested verification within 90 days of the date of termination, reinstate MAGI MA back to the date of termination by the 30th business day following the date the last piece of verification was provided.

·         If non-MAGI MA was terminated due to failure to provide requested verification and the individual provides all the required verification within the 10 days following the end of the advance notice period:

-         have the individual fill out DFA Form 800 or DFA Form 800MA, with their name, address, and signature;

-         ensure that no other changes have occurred in the case that would affect eligibility and that no new program services have been requested on DFA Form 800 other than those which were originally terminated;

-         if the individual meets all program eligibility requirements, reinstate assistance based on the new application date, with no new interview required; and

-         generate medical benefits in accordance with PART 121, INITIATION OF MEDICAL ASSISTANCE, assuming the individual has requested retroactive medical assistance back to the date of closing, if applicable.

References: He-W 606.01; He-W 606.100-606.101; He-W 844.01; He-W 883.01; He-W 884.01-.02; RSA 161:4-a, X(a) & (g); 42 CFR 435.914(a); 42 CFR 435.916; 45 CFR 206.10(a)(9)